RN Case Manager

Position Summary The RN Care Manager performs the initial comprehensive assessment on admission in accordance with the Care Management Department policy, screening all patients by utilizing established tools for high risk indicators (i.e. AIMS, Geisinger, polypharmacy) to ensure high risk patient populations receive the appropriate supportive services for discharge to prevent readmission and assess all populations for potential discharge planning needs. Provides ongoing reassessment of needs throughout the hospital course. Performs UR activity per department policy.

Essential Functions And Responsibilities Includes The Following

Understands and adheres to the Hospital Performance Standards, Policies and Behaviors

Completes a comprehensive initial assessment.

Performs all activities for multidisciplinary care coordination at the intra-hospital level of care and inter-hospital level of care.

Performs all transitional planning activities including but not limited to:

Patient/caregiver education

Arrangement of all aftercare

Commercial payer involvement

High utilizer patient root cause

Communicates and collaborates all relevant patient information to appropriate health team members.

Ensures department goals of LOS reduction, readmission prevention, denial reduction, and satisfaction improvement are realized.

Documents per department requirements.

Participates in Performance Improvement activities as needed.

Performs All UR Activities Per Department Policy

Commercial payer reviews

Disposition determination,

Retro/self-audit

MC variance

Admission clinical review.

Performs all other related duties as assigned

Education & Experience Requirements

BSN or related Bachelor's degree required

5 years clinical ED, critical care or med/surg experience required

Previous Case Management Experience Preferred

Knowledge of healthcare financial, regulatory, and payer issues preferred

Knowledge of state, local, and federal programs strongly preferred

Experience in use of Milliman/InterQual criteria

Registered Nurse (RN) NYS license required

PRI/Screen certification strongly preferred.

C.C.M. (Certified Case Manager) certification preferred

Computer Skills Essential

Core Competencies

Demonstrates ability to establish two-way communication by clearly defining expectations, communicating utilizing a variety of methods, actively listening to ideas and concerns and responding in an appropriate manner.

Demonstrates ability to delegate responsibilities appropriately.

Demonstrates ability to retain composure under stress and perform multitasking functions.

Physical/Mental Demands/Requirements & Work Environment

May be exposed to chemicals necessary to perform required tasks. Any hazardous chemicals the employee may be exposed to are listed in the hospital's SDS (Safety Data Sheet) data base and may be accessed through the hospital's Intranet site (Employee Tools/SDS Access). A copy of the SDS data base can also be found at the hospital switchboard, saved on a disc.

Must be physically able to walk, stand and/or sit for extended periods of time, with the ability to carry necessary equipment (i.e., IPad or laptop) on rounds. Must be able to perform difficult manipulative, arm-hand steadiness and hand-eye coordination skills. Must be able to meet all regulatory requirements. Demonstrates ability to follow written and oral instructions required for the position.

Demonstrates ability to analyze multidimensional problems into component parts and sort out tasks in priority order to solve the problem.

Must be able to see object closely and far away, hear normal sounds with some background noise. Communicates effectively verbally and in writing.